Analisa Gas Darah akibat

Ketidakseimbangan Elektrolit
Gogma Firmansyah Sirait
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KEADAAN PATOLOGIS PENYEBAB DEHIDRASI

 Gastroenteritis (diare dan muntah)

Tergantung derajat dehidrasi, kebutuhan cairan menurut
Skor Daldiyono

 Kenaikkan suhu tubuh (Demam)

Kenaikkan suhu 1 0C kebutuhan cairan meningkat
12%

 Luka Bakar (Rules’s Of Nine)

 Stomatitis dan Faringitis

 Ketoasidosis diabetes (KAD)

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Tabel. Jumlah Elektrolit Yang Hilang Akibat Sekresi
Tubuh
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KETIDAKSEIMBANGAN CAIRAN
DEHIDRASI
KEADAAN PENURUNAN JUMLAH
KOMPARTEMEN CAIRAN DALAM TUBUH

1. Hilangnya cairan (keadaan patologis)

2. Asupan air tidak adekuat
3. Hilangnya elektrolit
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TERAPI CAIRAN PADA KEDARURATAN DEHIDRASI
(SYOK HIPOVOLEMIA)
PEMBERIAN CAIRAN PARENTERAL DIBERIKAN SAAT
 TERAPI INISIAL : PEMBERIAN ORAL TIDAK LAGI MENCUKUPI
Kristaloid : Ringer Laktat atau NaCl 0,9%
Jumlah cairan : 20 ml/kgBB
Pantau hemodinamik

Tidak ada respon

60 ml/kgBB

 TERAPI PEMELIHARAAN (kebutuhan berdasarkan berat badan) – HOLLIDAY

SEGAR
 Berat badan < 10kg = 100 mL/kgBB
 Berat badan 10 – 20 kg = 1000 + 50 ml/kgBB
 Berat badan > 20kg = 1500 + 20 ml/kgBB
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Chloride imbalance
Hypochloremia : < 96 mEq/L
ETIOLOGY
Losses through skin. GI track,
Kidney
Can also be related to changes
in sodium levels and/or acid-
base levels
ASSESSMENT FINDINGS
Agitation, irritability
Hypereactive deep-tendon
reflexes
Muscle cramps and tetany
Slow, shallow respirations
Weakness
Seizures/coma
arrhytmias
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Hyperchloremia >106 mEq/L

ETIOLOGY ASSESSMENT FINDINGS

Increase sodium chloride Decrease level of
intake, especially if water consciousness
is lost
Rapid, deep-breathing
(Kusmaul’s)
Weakness
Agitation
Tachypnea, dyspnea
Tachycardia
Hypertension, edema
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Calcium balance

HYPOCALCEMIA  serum calcium < 8,9 mg/dl

Etiology Assessment findings
Parathyroid deficiency Tingling in hands, fingers, feet,
or around the mouth
Vit D deficiency tetany
Renal disease laryngospasm
cancer Positive Trousseau’s sign,
chvostek’s sign
pancreatitis seizure
Massive blood transfusion Cardiac arrest
Edema or laxative abuse
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Hypercalcemia  serum calcium >10,1 mg/dl

ETIOLOGY ASSESSMENT FINDINGS

Cancer Muscle weakness, leak of
coordination

Excessive intake of vitamin D Confusion, impaired memory

Excessive intake of milk or Lethargy
alkaline antacids

Hyperparathyroidism N & V constipation

Immobilization Pruritus
Reduce renal function Kidney stones
Bone pain
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Pottasium imbalance
HYPOKALEMIA < 3,5 mEq/L
ETIOLOGY
Abnormal loss of pottasium (~
diuretics, vomiting, diarrhea)
Inadequate replacement of lost
potassium
ASSESSMENT FINDINGS
Muscle weakness (begins in
lower extremities and moves up
trunk)
Impaired respiratory muscle
function
Abdominal distension, N & V,
constipation
Increase urination and thirts
Dysrhythmia and ECG changes
Elevated blood glucose levels
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Hyperkalemia  > 5 mEq/L

ETIOLOGY ASSESSMENT

Kidney failure Anxienty

Celluler damage Irritability

Insulin deficiency GI hyperactivity (diarrhea,

cramping)

Adrenal deficiency ECG changes

Rapid infusion of pottasium Cardiac dysrhythmias

Cardiac arrest
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Phosphorus imbalance

HYPOPHOSPHATEMIA : < 2,5 mg/dl

ETIOLOGY ASSESSMENT FINDINGS

Increased carbohydrate Weakness, especially
calories respiratory muscle

Respiratory alkalosis Myocardial depression,

ventrikular disrhythmias

Alcholism Fatigue, confusion, coma

Incontrolled diabetes mellitus Bone changes
Renal phosphate wasting Insulin resistance
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Hyperphosphatemia  >4,5 mg/dl

ETIOLOGY ASSESSMENT

Renal failure Will have coexisting

hypocalcemia and assessment
findings are the same

Tumor lysis syndrome

Excess phosphate intake

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Magnesium Imbalance

HYPOMAGNESIUM  <1,5 mEq/L

ETIOLOGY ASSESSMENT FINDINGS

Impaired intake Tremors

Impaired intestinal absorption Cramps

Excessive urinary excretion Difficulty swallowing

(secondary to diuretics and
chronic alcoholism)

CV changes
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Hypermagnesium  >2,5 mEq/L

ETIOLOGY ASSESSMENT FINDINGS

Renal failure Hypotension

Diabetic ketoacidosis Weakness

Magnesium sulfate therapy Depressed reflexes

Magnesium based laxative Paralysis

bradykardia

Respiratory failure

Cardiac arrest